Chapter 20: The Kidney Flashcards
What is the most common and 2nd most common causes of Chronic Renal Failure (CRF) and End-Stage Renal Disease (ESRD)?
- Diabetes = MOST common
- High BP = second most common
What is the single most important question to ask a patient suspected of having renal disease?
Why?
- - “Have you had this before?”
- Hx of disease can imply a significantly worse prognosis or chronicity
What is the average size of the kidney?
- 120-150 grams and continues to grow until late teens/early 20s
- Length: 10-12 cm
- Width: 6cm
How is the hilar area of the kidney different from the parenchyma?
Hilar, ureter and urinary bladder are lined by transitional cell epithelium
Why is the right kidney lower than the left?
Liver pushes it down
Where is the kidney located?
Renal angle: between the lower border of the 12th rib and lateral border of the erector spinae muscle.
If a patient comes in with kidney pain, what is its distribution?
Starts from renal angle and radiates forward (anterior) towards the groin.
How are the kidneys attached?
- Fascial plane, renal artery and vein, ureter and mesentary.
- There are NO suspensory ligments.
But what about the splenorenal ligament, is that a suspensory ligament that holds the kidney in place?
No
Do all small tumors form a mass?
NOOOO.
What is creatinine and in kidney dysfunctions, it is ↑ or ↓ ?
What about BUN levels?
-
Creatnine is a breakdown product of muscle metabolism. Usually, it is excreted NL.
- If kidney dysfunction:
- ↑ serum creatinine and BUN (blood urea nitrogen)
-
↓ urine creatinine and BUN
*
- If kidney dysfunction:
When is a renal biopsy performed?
Because of the invasivness, there must be DEFINITE indications of a kidney dysfunction.
What is always performed with a renal biopsy?
UA
Kidney diseases often result in edema.
What causes generalized edema vs localized edema?
- Generalized edema: Heart, kidney and liver failure
- Localized: only lung failure
Renal diseases can be catagorized based on what 4 compartments of the kidneys?
- Glomeruli (often immunologically mediated)
- Tubules (often toxic/infectious inury)
- Interstitium
- Blood vessels
In the kidneys,
- DM is mainly a __________ disease.
- Systemic HTN is mainly a _________ disease.
- DM= glomerular disease
- HTN= tubulointestinal disease (d/t vascular damage)
Glomerular disorders are though to be due to what?
Immunologic diseases (primary or secondary)
What is responsible for the long-term complications in diabetics?
Persistant hyperglycemia (glucotoxicity)
Azotemia
↑ BUN & ↑ creatinine d/t a ↓ in GFR
Pre-renal Azotemia
Azotremia d/t hypoperfusion of the kindeys (d/thypotension, shock, CHF, or cirrhosis of liver) W/O damage of the parenchyma
Post-renal azotemia
Azotremia d/t urine outflow is obstructed after leaving the kidney (distal to calyces and renal pelvis). If the obstruction is removed, azotemia is corrected.
Uremia
Azotremia + other clinical findings and signs like: metabolic, hematologic, endo, GI, neuro and CV effects
If Puttoff says uremia, what is the condition of the patient?
They are in chronic kidney diasease (CKD, same as chronic renal failure)
How does a patient with uremia progress and present?
How do we dx in children?
- Pt has nonspecific sx, which become chronic and worse overtime as the disease worsens.
- Dx in children is hard because of the non-specific sx.
Azotremia is often seen in _________ syndromes
Nephritic syndromes
Know the difference between nephrotic and nephritic syndromes
What is the NL GFR?
90-120 mL/min/1.73m2
Older ppl will lower GFR bc it varies w age.
What is acute kidney injury (AKI)/acute renal failure?
Severe cases show?
Reversible?
-
Rapid decline of GFR due to glomerular, interstitial, vascular or acute tubular injury (ATN).
- Severe cases will show: oliguria or anuria
- Reversible, or can progress to CKD.
Injury to what morphological structure of the kidney is the most common cause of Acute Kidney Injury?
Acute tubular injury (ATN)